Provider Demographics
NPI:1336128008
Name:HINSHAW, KEITH A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:HINSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 BARCLAY CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4508
Mailing Address - Country:US
Mailing Address - Phone:248-853-9177
Mailing Address - Fax:248-853-7258
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4508
Practice Address - Country:US
Practice Address - Phone:248-853-9177
Practice Address - Fax:248-853-7258
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI438697710Medicaid
D85209Medicare UPIN
MIN2670001Medicare ID - Type Unspecified